Pierre Opdecam

Static and Dynamic Roentgenographic Analysis of Ankle Stability in Braced and Nonbraced Stable and Functionally Unstable Ankles

Patients suffering from functional ankle instability were selected based on a structured interview. Talar tilt was measured using supine ankle stress roentgenographs and standing talar tilt was measured using erect ankle stress roentgenographs. A digital roentgenocinematographic analysis of a 50° ankle sprain simulation was performed to measure dynamic talar tilt and inversion distance between two video images (inversion speed). A significant decrease in pathologic supine talar tilt in unstable ankles was found in the braced compared with the nonbraced situation (talar tilt 13.1° versus 4.8° with brace). The talar tilt with the brace after activity was still significantly lower than the initial value without the brace. The standing talar tilt of unstable ankles was shown to be significantly lower with the orthosis than without (standing talar tilt 16.6° versus 12.0° with brace). Roentgenocinematographic evaluation of ankle sprain simulation showed that the mean dynamic talar tilt during simulated sprain decreased significantly in the braced ankles compared with the nonbraced ankles (dynamic talar tilt 9.8° versus 6.4° braced). A significant decrease in the digital measurement of inversion distance (from 110.6 pixels to 92.4 pixels) was observed in the total sample of 39 ankles during the initial high-speed phase of the simulated sprain. The brace significantly slows down the inversion speed.

Surgical treatment of acute type-V acromioclavicular injuries in athletes

SummaryIn a prospective study, 18 consecutive athletes with an acute type-V acromioclavicular sprain were treated with a coracoclavicular repair using a double velour Dacron graft. All patients were reviewed after a mean follow-up period of 6 years (range: 2–9 years). At follow-up, 12 patients (66.7%) showed a good or excellent result according to the Imatani evaluation system, and six patients (33.3%) demonstrated a fair or poor result according to the same system. Loss of reduction was encountered in eight shoulders (44.4%) despite an initial anatomical reduction. No correlation was seen between the overall scores at follow-up and the degree of residual dislocation, between the overall scores and the presence of coracoclavicular calcifications or ossifications, between the overall scores and the development of post-traumatic arthritic changes, or between the overall scores and the presence of osteolysis of the distal clavicle.

Nonunion of a comminuted intra-articular wrist fracture after external fixation - A case report and review of the literature

SummaryNonunion is a very rare complication of a comminuted intra-articular wrist fracture treated by external fixation. The authors describe the likely reasons and the after-care, in order to avoid this complication.

Traction-suspension therapy for unstable glenoid neck fracture

further into the pelvis during this period. Certainly, at operation it could not be visualized, and no force was used in trying to locate it with the coupling screw, though the possibility does exist that it may have been pushed in unknowingly by the operating surgeon. The ease with which thrs may have occurred indicates that the screw may have tracked into the retroperifoneal region during some of the patient’s falls, a fact not fully appreciated from the preoperative radiograph (Figure I). The failure to use the compression screw during internal fixation made it impossible to extract the implant in one piece, as is usually possible when the fixation in the femoral head is poor. There is a feeling that compression should not be used in porotic bones for fear of the threads cutting oui, and that its use does not affect the outcome of a femoral neck fracture in terms of union (Fransden et al., 1984). Whereas these are logical assumptions, in view of the difficulty encountered in removing this screw, and the potential risks of penetrating acetabular screws (Keating et al., 1990). it is recommended that the compression screw be used in all fixations, but tightened only if the bone quality is judged to be adequate. Case reports 57